Provider Demographics
NPI:1598839177
Name:SUN, GRACE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 N DOHENY DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1726
Mailing Address - Country:US
Mailing Address - Phone:310-274-4200
Mailing Address - Fax:310-274-5901
Practice Address - Street 1:462 N DOHENY DR
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1726
Practice Address - Country:US
Practice Address - Phone:310-274-4200
Practice Address - Fax:310-274-5901
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist